Provider Demographics
NPI:1861483331
Name:HANSON, ERIC C (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:C
Last Name:HANSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 W BIG BEAVER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-3501
Mailing Address - Country:US
Mailing Address - Phone:248-643-8633
Mailing Address - Fax:248-643-8680
Practice Address - Street 1:1663 W BIG BEAVER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3501
Practice Address - Country:US
Practice Address - Phone:248-643-8633
Practice Address - Fax:248-643-8680
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301045920208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4631975Medicaid
MI4631975Medicaid
MIE37470Medicare UPIN